Job Description

Work for Indiana

Begin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and measurable impact on the lives of Hoosiers across Indiana.

About the Family & Social Services Administration:

The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services Administration, which receives around 18 percent of the state's budget to ensure vital health care coverage to approximately 1 in 4 Hoosiers. OMPP strives to build programs and processes that enable Hoosiers to live in fully engaged communities and reach their greatest emotional, mental, and physical well-being. Our mission is to support individual and community well-being with effective and efficient programs, remarkable collaborations, measurable impact on individuals and communities, and an energized staff that is fully engaged with this mission.

Role Overview : 

Along with shared management of the pharmacy benefit Statewide Uniform Preferred Drug List (SUPDL); establishment of Fee-For-Service PA criteria; and analysis of drug clinical, utilization, and cost data; the pharmacy clinical programs and policy manager:

• Performs reviews, makes coverage determinations, and establishes PA criteria for HCPCS coded drugs
• Manages the carved-out drug program
• Manages pharmacy related non-drug programs such as the Preferred Diabetes Supplies List rebate program
• Provides utilization and financial forecasting for high impact pipeline drugs
• Provides oversight of the managed care drug benefits, including managed care compliance with the SUPDL

Salary Statement : 

The salary for this position traditionally starts at $109,304.00 but may be commensurate with education or work experience.

A Day in the Life:

The essential functions of this role are as follows: 

• Initiate, contribute, and recommend changes to pharmacy program policies, procedures, and work standards to maximize efficient operations of the program. 
• Act as a technical resource regarding all Medicaid pharmacy concerns, clarifying and interpreting all procedures, providing references, and resolving disputed issues. 
• Review and provide input on all forms of communication utilized for the pharmacy program administration to include banners, bulletins, provider manuals and inquiries. 
• Conduct client acceptance testing for claims processing changes. 
• Develop, execute, and publish trend reports related to the Medicaid pharmacy benefit. 
• Evaluate current practices regarding the Medicaid pharmacy benefit to ensure compliance with all State and Federal regulations. 
• Research new Medicaid policies for the impact on the Pharmacy unit and its daily operations. 
• Serve as a liaison for both the Medicaid managed care plans and the medical policy group. 
• Some essential functions of this position may be performed onsite at the agency’s worksite or other assigned worksites while some essential functions of this position may be eligible for work from home authorization in accordance with policy. Remote work authorization is not automatic and is dependent upon operational needs and agency approval.

The job profile is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

This position is exempt from overtime compensation for additional work hours which may be required to complete essential functions or other assigned work. Exempt employees may work more than 75 hours in a pay period without additional compensation and must report a minimum of 75 hours per pay period of work hours and/or paid leave taken to receive their base biweekly salary.

What You'll Need for Success:

You must meet the following requirements to be considered for employment: 

• Doctor of Pharmacy (PharmD) degree from an accredited pharmacy program.
• Must have an active Indiana Board of Pharmacy licensure as a registered pharmacist. 
• Knowledge of federal and state OMPP programs and policies and the effect on Indiana Health Coverage Programs. 
• Knowledge of the federal Medicaid rebate program. 
• Basic understanding of federal Medicaid requirements. 
• Extensive knowledge of generally accepted pharmacy practices. 
• Specialized knowledge in prescription formularies and preferred drug lists. 
• Specialized knowledge of insurance billing processes and procedures.
• Thorough knowledge of eligibility rules/Medicaid claims payment processing. 
• Knowledge of policies and regulations pertaining to the distribution of pharmaceutical drugs. 
• Knowledge of the budgetary process. 
• Ability to communicate complex theories and principles orally and in writing. 
• Ability to plan and conduct professional and complex research. 
• Ability to manage medium sized projects.
• Able to perform essential functions with or without reasonable accommodation.

Supervisory Responsibilities/Direct Reports:

This role may be utilized in a supervisory capacity based on agency needs.

Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefit package for full-time employees which includes: 

• Three (3) medical plan options (including RX coverage) as well as vision and dental plans
• Wellness Rewards Program: Complete wellness activities to earn gift card rewards
• Health savings account, which includes bi-weekly state contribution
• Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities
• Deferred compensation 457B account (similar to 401k plan) with employer match
• Two (2) fully-funded pension plan options
• A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:
  • 150 hours of paid New Parent Leave and up to eight weeks of paid Childbirth Recovery Leave for eligible mothers
  • Up to 15 hours of paid community service leave
• Combined 180 hours of paid vacation, personal, and sick leave time off
• 12 paid holidays, 14 on election years
• Education Reimbursement Program
• Group life insurance
• Referral Bonus program
• Employee assistance program that allows for covered behavioral health visits
• Qualified employer for the Public Service Loan Forgiveness Program
• Free Parking for most positions
• Free LinkedIn Learning access

   

Equal Employment Opportunity:

The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process as well as perform the essential functions of a role. If you require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at jobs@spd.IN.gov .

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